Corporate Compliance

The week in Medicare updates

Medicare Insider, March 26, 2013

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CMS issues memo on access to statements of deficiencies

On March 22, CMS issued a memo on access to statements of deficiencies (CMS-2567) on the web for skilled nursing facilities, nursing facilities, hospitals, and critical access hospitals.

View the memo.

CMS issues transmittal on Part A to Part B rebilling of denied inpatient claims

On March 21, CMS issued a transmittal that implements the CMS Administrator’s ruling which permits providers to rebill inpatient Part A claims that are denied by a Medicare contractor for the reason that the inpatient level of care was not medically necessary for Part B payment for the full array of services provided without changing the patient’s status.

Effective date: March 13, 2013
Implementation date: July 1, 2013

View transmittal R1203OTN.

CMS issues model letter revisions

On March 22, CMS issued a transmittal that revises the model letters in Chapter 15 of the Program Integrity Manual and adds guidance and example letters.

Effective date: April 22, 2013
Implementation date: April 22, 2013

View transmittal R456PI.

CMS issues transmittal on implementation of the award for jurisdiction E A/B MAC

On March 21, CMS issued a transmittal that provides an update on the implementation of the jurisidction E Part A and Part B Medicare administrative contractor (JE A/B MAC). New workload numbers shall be assigned for the states of territories of California, Hawaii, Nevada, American Samoa, Guam, and the Nothern Marianas.

Effective date: July 1, 2013
Implementation date: July 1, 2013

View transmittal R1201OTN.

CMS replaces transmittal on supplemental security income

On March 21, CMS replaced transmittal R1141OTN, containing instructions that provide data for determining the disproportionate share adjustment for IPPS hospitals and the low income patient adjustments for IRFs.

View transmittal R1200OTN.

CMS issues NCA for aprepitant for chemotherapy-induced emesis
 
On March 20, CMS issued a national coverage analysis for aprepitant for chemotherapy inducued emesis.
 
View the NCA.
 
CMS issues final rule on requirements for LTC facilities notices of closure

On March 19, CMS issued in the Federal Register a final rule that outlines steps that long-term care facilities need to take if they decide to close.

View the final rule.

OIG issues Medicare compliance review of New Jersey hospital

On March 19, the OIG issued a Medicare compliance review of Saint Michael’s Medical Center in Newark, N.J. for the period of January 1, 2009 through June 30, 2011. The review found that 98 of 230 claims reviewed did not fully comply with Medicare billing requirements, resulting in overpayments totaling $492,000.

View the OIG report.



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